A new scientific paper was recently published in the American Journal of Emergency Medicine on the cardiovascular complications of coronavirus disease 2019 (COVID-19). According to the paper, more attention has been paid to the pulmonary complications of COVID-19, with less attention being paid to the cardiovascular complications that can result in death or impairment.1

The paper’s aim was to educate emergency medicine doctors who are treating patients with potential or confirmed COVID-19 on the dangerous cardiovascular complications of the virus. The authors explained that COVID-19 can cause complications such as heart failure, heart attacks, and blood clots, and can lead to strokes.1

"In writing this article, we hope to increase emergency physicians' knowledge and awareness of this new pathogen and its impact on the cardiovascular system," said William Brady, MD, professor of Emergency Medicine, Medicine, & Nursing Vice-Chair for Faculty Affairs, Department of Emergency Medicine, University of Virginia, in a press release. "As we encounter more and more patients with COVID-19-related illness, we are increasing our understanding of its impact on the body in general and the cardiovascular system in particular. The rate of learning on this area is amazingly rapid. Information continues to change weekly, if not daily."2

A particular concern for patients with COVID-19 is the potential for heart failure. According to a recent study the authors referred to in the paper, researchers found that 24% of COVID-19 patients suffer from acute heart failure when first diagnosed with COVID-19.1

However, the authors noted that this doesn't mean that 24% of all COVID-19 patients will suffer heart failure. They explained that it currently is unclear whether the heart failure was the result of COVID-19 or if the virus was exacerbating a preexisting but undiagnosed heart condition. Of the patients who did suffer from heart failure, approximately half were not known to have preexisting high blood pressure or cardiovascular disease.1

The authors explained further that since COVID-19, like other diseases of its kind, causes severe inflammation throughout the body, there is an increased risk of heart attack and stroke. Inflammation causes fatty plaque build-up in the blood vessels, which has the potential to rupture, resulting in a heart attack or stroke.1

It is especially important to note, the authors explained, that some COVID-19 treatments interact with medicines used to treat cardiovascular conditions. For example, the malaria drug hydroxychloroquine can interact with medications designed to regulate heart rhythm. Additionally, interactions with hydroxychloroquine can cause heart damage and worsen cardiomyopathy.1

Furthermore, remdesivir, an antiviral that is the only COVID-19 treatment authorized by the FDA, can cause low blood pressure and abnormal heart rhythm. These potential interactions are crucially important for physicians to keep in mind when treating patients with COVID-19, according to the paper.1

"As we gain more experience with this new pathogen, we realize that its adverse impact extends beyond the respiratory system," Brady said in a press release. "We will continue to learn more about COVID-19 and the most optimal means of managing its many presentations."2

REFERENCES
  1. Long B, Brady WJ, Koyfman A, et al. Cardiovascular complications in COVID-19. American Journal of Emergency Medicine. 2020. sciencedaily.com/releases/2020/05/200515115644.htm. Accessed June 5, 2020.
  2. Heart attacks, heart failure, stroke: COVID-19's dangerous cardiovascular complications [news release]. University of Virginia Health System; May 15, 2020. doi: 10.1016/j.ajem.2020.04.048.